Introduction: Unplanned extubations (UE) are critical adverse events associated with increased risks of medical complications and prolonged hospital stays. Previous studies defined numerous clinical factors that are associated with an increased likelihood of an UE. However, this has not been widely studied in recent years, especially since the COVID-19 pandemic. Updated data allows us to reflect on previous quality improvement initiatives and better define safety precautions to prevent future events. This study aimed to characterize UE events in a large tertiary academic center after the COVID-19 pandemic. Methods: This was a retrospective, descriptive review of all adult patients who experienced an UE at a tertiary academic hospital between January 2021 and December 2023. This included all events that occurred in surgical, medical, cardiovascular, and neurosurgical ICUs. Data collected included patient age, sex, BMI, primary diagnosis, and primary medical service. Duration of intubation, event time, and vent settings at time of the event were recorded. Finally, clinical outcomes including reintubation and/or mortality were recorded. Results: 84 cases met the criteria for a UE event. The median patient age was 60 years, with 61% male and 39% female patients. Most events occurred among patients in the medical ICU (34%). 68% of all events occurred during daytime shifts (defined as 0700 – 1900), and 31% of cases occurred within two hours of nursing shift change (defined as 0500 – 0900 and 1700- 2100). 58% of patients were on pressure support (PSV) at the time of UE as opposed to controlled vent modes. 45% of patients were on some form of continuous sedation at time of UE, with the most common class of medication used being narcotics. 35% of patients were reintubated following the UE, and the remaining population was managed with noninvasive oxygen delivery. Conclusions: UE events remain a significant safety concern in tertiary care settings. Our study highlights specific factors that may increase the risk of UE such as male sex, daytime shift, and PSV vent settings. Going forward, we will further extrapolate the data to see if these groups also experience increased reintubation and/or mortality. Future efforts should focus on targeted protocols and staff education to mitigate risk and improve patient outcomes.
Katari et al. (Sun,) studied this question.